65W-16789-74842
4 vaccinations
6 coded responses
42 check-ins
6 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 910 / CA
- Registered
- 2021-02-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-04
Dose 1 — Pfizer-BioNTech
-
2021-02-16
Registered in v-safe
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2021-02-16
Survey response — day 7, dose 1MedDRA: Confusional state — Feeling: Good · Site: Redness, SwellingFree text: I think I may be having mild neurological effects. Several times since vaccine I have felt suddenly confused. This is very unlike me.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-18
-
2021-02-25
Dose 2 — Pfizer-BioNTech
- 2021-02-25
-
2021-02-26
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-01
- 2021-04-08
- 2021-05-27
-
2021-08-26
Survey response — 6 months, dose 2MedDRA: Anxiety, Dysphagia, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: I have had trouble swallowing at times..Barium swallow test next weekMay have nothing to do with vaccine, I know. Just thought I would let you know.I feel more anxiety than I am used to, but that just may be the times · Healthcare visit (other): Normal in person doc apptMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-08-26
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-09-24
Dose 3 — Pfizer-BioNTech
-
2021-09-29
Survey response — days 1–6 daily, dose 3MedDRA: Headache, Mental impairment, Pyrexia — Feeling: Good · Be unable to do your normal daily activitiesFree text: On day 2 after shot had fever and headache so bad I could not think. All ok after 24 hrs!MedDRA releases: 2024-11 · check-in free text available
- 2021-09-30
- 2021-10-01
-
2021-10-08
Survey response — day 14, dose 3MedDRA: Aphasia, Memory impairment — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: I am having short term memory problems and word retrieval problems.MedDRA releases: 2024-11 · check-in free text available
-
2021-10-08
Report sent to call center — day 14, dose 3Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2021-10-12
Call successfulParticipant prefers to complete VAERS report online
- 2021-10-15
- 2021-10-22
- 2021-10-29
- 2021-11-05
- 2021-12-24
- 2022-03-25
-
2022-05-05
Dose 4 — Moderna
- 2022-05-05
-
2022-05-06
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Redness, Swelling · Fever · Headache · Be unable to do your normal daily activitiesAdult check-in
-
2022-05-07
Survey response — days 1–6 daily, dose 4MedDRA: Nervousness — Feeling: Fair · Site: Swelling · Fever · Fatigue or tirednessFree text: Very "nervous" feelingMedDRA releases: 2024-11 · check-in free text available
- 2022-05-08
- 2022-05-09
- 2022-05-10
- 2022-05-11
- 2022-05-12
- 2022-05-19
- 2022-05-26
- 2022-06-02
- 2022-06-09
- 2022-06-16
-
2022-08-04
Survey response — 3 months, dose 4MedDRA: Emergency care, Exposure to SARS-CoV-2, Malaise, SARS-CoV-2 test negative, Thrombosis — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Blood clot in my left leg. My daughter test positive for covid wk of 7/4. I never tested positive, but didn't feel well for a couple of days. Went to ER on 7/6 with clot. Am on blood thinner for a few months. We figure clot was provoked event.MedDRA releases: 2024-11 · check-in free text available
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2022-08-04
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2022-08-05
-
2022-08-09
Call successfulParticipant prefers to complete VAERS report online
- 2022-11-03
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Pfizer-BioNTech | |
| 2 | 2021-02-25 | Pfizer-BioNTech | |
| 3 | 2021-09-24 | Pfizer-BioNTech | No |
| 4 | 2022-05-05 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 4 — day 7, dose 1
Systemic reaction (other): I think I may be having mild neurological effects. Several times since vaccine I have felt suddenly confused. This is very unlike me.
Release 9 — 6 months, dose 2
Symptoms: I have had trouble swallowing at times..Barium swallow test next weekMay have nothing to do with vaccine, I know. Just thought I would let you know.I feel more anxiety than I am used to, but that just may be the times
Healthcare visit (other): Normal in person doc appt
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): On day 2 after shot had fever and headache so bad I could not think. All ok after 24 hrs!
Release 10 — day 14, dose 3
Symptoms: I am having short term memory problems and word retrieval problems.
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Very "nervous" feeling
Release 12 — 3 months, dose 4
Symptoms: Blood clot in my left leg. My daughter test positive for covid wk of 7/4. I never tested positive, but didn't feel well for a couple of days. Went to ER on 7/6 with clot. Am on blood thinner for a few months. We figure clot was provoked event.
Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".
MedDRA terms by release
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | Office visit | ✓ | · | ✓ |
| SD | Anxiety | ✓ | · | ✓ |
| SD | Aphasia | · | · | ✓ |
| SD | Dysphagia | ✓ | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Exposure to SARS-CoV-2 | · | · | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Memory impairment | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Thrombosis | · | · | ✓ |
| SRO | Confusional state | ✓ | ✓ | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Mental impairment | · | · | ✓ |
| SRO | Nervousness | · | · | ✓ |
| SRO | Pyrexia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release